Global conflicts have doubled over the past five years. In 2024, one in eight people was exposed to political conflict.[i] Unsurprisingly, one consequence of conflict is a significant burden of trauma and mental health issues, with more than one in five people in conflict-affected countries reported to be suffering from diagnosable mental health disorders at any point in time.[ii] An even larger number of people are likely to be affected by a wider range of psychosocial problems related to conflict trauma.

Despite this, only 0.3% of health-allocated foreign aid is spent on mental health.[iii] This has wide-reaching implications, ranging from the continued suffering of affected populations to the perpetuation of existing conflict. As part of the Cross-Border Conflict Evidence, Policy and Trends (XCEPT) programme, our multidisciplinary team of researchers at King’s College London is studying the connection between trauma, mental health, and violence in our Impact of Trauma Survey (IoTS), with the hope of informing efforts to break cycles of violence.

Breaking cycles of conflict

It is known that some of those who experience the trauma of conflict are more likely to engage in violence themselves, creating what has been called a ‘cycle of violence’.[iv] However, the role of trauma and mental health problems in driving further violence, or in blocking reconciliation efforts, is under-researched. Using an extensive psychometric survey fielded in Iraq, Lebanon, and South Sudan, we hope to better understand the factors that contribute to people’s attitudes to reconciliation and violence in order to interrupt these cycles.

Alongside the IoTS, we will be testing various psychological interventions through a complementary study in Iraq. Participants will take part in an intervention ‘tournament’, which will test different approaches to promoting reconciliation. The most effective intervention from the tournament will be scaled up in a randomised controlled trial (RCT). By including IoTS participants in these interventions, we can use baseline data from the IoTS to examine in greater detail how psychological interventions work among different subpopulations, and how factors such as mental health might influence how effective these interventions are.

The connection between trauma, mental health, and conflict

Building on existing research, the IoTS examines the psychological effects of conflict exposure on individuals, exploring how trauma and mental health might influence political beliefs and behaviours. Recognising that many participants may have witnessed events such as bombings, experienced the loss of loved ones, or seen people killed, we are looking at the association between these experiences, mental health, and propensity to violence. To capture a more comprehensive picture beyond conflict, we are also examining other trauma that people may have suffered, such as childhood abuse, neglect, and exposure to domestic violence.

We will supplement the quantitative data collected in the IoTS with hundreds of semi-structured interviews and life histories that will allow participants to tell their personal stories of conflict in their own words. This will also enable them to share stories that have been passed down through generations that can contribute to intergenerational trauma. By taking this wider perspective, and using both quantitative and qualitative data, we aim to account for the layered nature of trauma in conflict-affected populations, rather than attributing it solely to war-related experiences, and to avoid reducing it to a narrow clinical conceptualisation of trauma.

How psychology and society interact to drive conflict

While there is an association between trauma-related mental health problems and the risk of using violence, most of those with mental health problems never become violent. This is because a vast range of individual and societal factors interact to shape people’s responses to trauma. People develop in nested contexts: growing up in a family, which is embedded in a community, which is part of a society. Factors at these different levels interact with each other to shape how people think, feel, and behave. Examining individual factors within their broader context can uncover systemic issues, such as government neglect in regions with high rates of trauma and mental health issues.

The IoTS is novel in the way it incorporates wider societal dimensions into its analysis, instead of focusing narrowly on mental health. Participants are asked about a range of social and political factors, including social support, social cohesion, their trust in institutions, identity, experiences of discrimination, sense of threat to their community, and perceptions of their community’s ability to bring about change (known as collective efficacy). Our more open-ended semi-structured interviews and life histories will also ask about wider social experiences, such as social exclusion, social norms, reconciliation, justice, and forgiveness.

Overall, it is the interplay between individual and societal factors that drives violence. Our broad approach will enable us to investigate this interaction, providing a richer understanding of the dynamics at play in conflict and post-conflict settings.

Studying conflict trauma where it is needed most

Many studies on conflict trauma focus on particular population samples, such as army veterans or members of armed groups. To gain a comprehensive understanding of the factors associated with the support of violence or of peace, however, we have recruited participants from varied backgrounds.

Most previous research has also been conducted in WEIRD (Western, Educated, Industrialised, Rich, and Democratic) countries, and so existing measures have typically been developed in those contexts. To ensure relevance, we have worked with our partners in each country, as well as local and regional experts, to ensure that the IoTS is tailored to each context, using locally developed measures where available, or adapting scales for use across different fragile and conflict-affected settings.

In South Sudan, we used the South Sudan Mental Health Assessment Scale, recently developed by a team working in the country, which measures mental health problems in terms commonly used to express and make sense of distress in that context.[v] For example, in South Sudan, people may describe having ‘pain in the heart’ rather than using terms that are more familiar in the West, such as depression. Where locally developed scales were not available, we took a multi-step approach to adapting and piloting existing measures. This included working with local translators to translate measures; carrying out cognitive interviewing with a diverse range of people to establish how they understood the questions and to identify sensitive topics; and pilot testing the measures in local populations.

We hope the development of this survey can inform future research by sharing measurement tools and practical and ethical frameworks for research in conflict-affected settings and, ultimately, making data available for other researchers to use.

How do violent attitudes change over time?

With data collected from 2023 to 2025, the longitudinal design of the IoTS adds another dimension to this research. In Iraq, we are conducting the IoTS in two waves, following up with participants around six months later. This will allow us to examine how changes in individual or social factors – such as mental health or trust in institutions – may alter people’s attitudes toward violence. These findings will be enriched by integrating external data sources, such as the ACLED (Armed Conflict Location & Event Data) database. Using detailed records of incidents of political violence, especially those that occur between survey waves and close to where research participants live, we will explore how these events influence attitudes to violence and peace.

The IoTS offers a unique opportunity to test diverse hypotheses of pathways to violence across multiple countries, leveraging a combination of psychological, social and political factors. By looking at a wide variety of questions, such as how perceptions of injustice predict support for different types of political action, and whether trauma-related mental health problems, collective trauma or competitive victimhood affect attitudes towards reconciliation and violence, we hope this study can inform interventions to break cycles of violence in conflict-affected regions.

As of May 2025, IoTS data collection has been completed in South Sudan (fieldwork was carried out in 2024) and for the first wave in Iraq (fieldwork was carried out in 2024-25). The second wave in Iraq and data collection in Lebanon are set to be completed by autumn 2025. Initial findings will be shared later this year – follow @ICSR_Centre and @XCEPT_Research on X to stay up to date with our research.

[i] ACLED. (2025) Acled conflict index: Global conflicts double over the past five years. Available at: https://acleddata.com/conflict-index/ (Accessed: 18 March 2025).

[ii] Charlson, F. et al. (2019) ‘New WHO prevalence estimates of mental disorders in conflict settings: A systematic review and meta-analysis’, The Lancet, 394(10194), pp. 240–248. doi:10.1016/s0140-6736(19)30934-1.

[iii] United for Global Mental Health. (2023) Financing of mental health: the current situation and ways forward. rep. Available at: https://unitedgmh.org/app/uploads/2023/10/Financing-of-mental-health-V2.pdf

[iv] Lumsden, M. (1997) ‘Breaking the cycle of violence’, Journal of Peace Research, 34(4), pp. 377–383. doi:10.1177/0022343397034004001.

[v] Ng, L.C. et al. (2021) ‘Development of the South Sudan Mental Health Assessment Scale’, Transcultural Psychiatry, 59(3), pp. 274–291. doi:10.1177/13634615211059711.